Meropenem Rate of Infusion: Guidelines for Clinical Practice
Meropenem should be administered by intravenous infusion over approximately 15-30 minutes for standard dosing, with extended infusion of 3-4 hours recommended for severe infections, especially when treating bacteria with high MICs. 1, 2
Standard Administration Guidelines
Normal Renal Function
- Standard dosing: 500 mg every 8 hours for skin/soft tissue infections or 1 gram every 8 hours for intra-abdominal infections 1
- Standard infusion rate: 15-30 minutes 1
- Alternative administration: May be given as IV bolus injection over 3-5 minutes (for doses up to 1 gram) 1
Impaired Renal Function
Dosage adjustment based on creatinine clearance:
- CrCl >50 mL/min: Standard dose every 8 hours
- CrCl 26-50 mL/min: Standard dose every 12 hours
- CrCl 10-25 mL/min: Half standard dose every 12 hours
- CrCl <10 mL/min: Half standard dose every 24 hours 1, 2
Optimized Administration for Severe Infections
For critically ill patients or when treating bacteria with high MICs, extended infusion provides pharmacodynamic advantages:
- Extended infusion: Administer over 3-4 hours to improve clinical and microbiological efficacy 3, 2
- Continuous infusion: Consider for severe infections with risk of pharmacodynamic failure (deep infection sites, major pharmacokinetic changes, high MIC) 3, 2
Special Considerations
Continuous Renal Replacement Therapy
- CVVH (Continuous Venovenous Hemofiltration): 1 gram every 8 hours is recommended for patients with severe infections undergoing CVVH 4
- CVVHDF (Continuous Venovenous Hemodiafiltration): 500 mg every 12 hours may be sufficient 5
Elderly Patients
- For patients over 59 years old with compromised renal function, consider reducing the dose to 10 mg/kg 2
Pharmacodynamic Principles
The efficacy of meropenem is time-dependent, requiring:
- Plasma concentrations above MIC for at least 70% of the dosing interval 3
- Higher target (Cmin/MIC of 4-6) for optimal efficacy in critically ill patients 3
Clinical Pearls and Pitfalls
- Common pitfall: Standard short infusions may not achieve adequate time above MIC for less susceptible organisms
- Solution: Extended infusion (3-4 hours) improves target attainment without increasing daily dose
- Stability consideration: Solutions prepared with Sodium Chloride 0.9% may be stored for 1 hour at room temperature or 15 hours refrigerated; solutions with Dextrose 5% should be used immediately 1
- Therapeutic drug monitoring: Consider for critically ill patients to optimize dosing and prevent treatment failure or antimicrobial resistance 6
By following these guidelines for meropenem infusion rates, clinicians can optimize antimicrobial efficacy while minimizing the risk of treatment failure and development of resistance.